# A systematic review of patient and healthcare professional perceptions of the barriers and facilitators to embedding exercise in the adjuvant cancer treatment pathway

## TL;DR

This study reviews how patients and healthcare professionals view the challenges and supports for including exercise in cancer treatment.

## Contribution

It systematically maps barriers and facilitators to the COM-B model and TDF for embedding exercise in cancer care.

## Key findings

- Three core themes emerged: exercise intervention, organisational setting, and impact of cancer.
- Barriers and facilitators were relevant to all COM-B constructs and several TDF domains.
- Key factors include knowledge, resources, motivation, and access to credible practitioners.

## Abstract

Evidence suggests that physical activity and exercise interventions can mitigate cancer treatment side effects. However, an improved understanding of how physical activity/exercise can be embedded within cancer care pathways is needed. We examined what is known about the barriers and facilitators to implementing physical activity/exercise interventions in the adjuvant cancer treatment pathway from a patient and healthcare professional perspective. The protocol was registered a priori with PROSPERO in March 2023.

Electronic databases (CINAHL Plus, MEDLINE, PsycINFO and Cochrane) were searched for quantitative, qualitative, and mixed methods evidence from 2004 to 2025. Quality appraisal was undertaken using the appropriate Critical Appraisal Skills Programme tools. Barriers and facilitators were inductively coded into themes and then mapped to the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Thematic meta-synthesis was applied to the data.

Fifteen qualitative, twelve quantitative and two mixed methods studies met the inclusion criteria. Three core themes emerged that influenced implementation: exercise intervention, organisational setting and impact of cancer. The barriers and facilitators identified by patient and healthcare professional participants were relevant to all the COM-B constructs, with the most prevalent TDF domains being skills, knowledge, environmental context and resources, social influences and optimism.

Findings emphasise knowledge and education, previous experience with exercise, resources, motivation, gender, age, social factors, positive promotion, individualised programming throughout treatment and access to credible practitioners as nuanced perspectives between patients and healthcare professionals. These converging perspectives are influential determinants to help identify potential solutions for embedding exercise within cancer treatment pathways.

The online version contains supplementary material available at 10.1007/s00520-026-10553-w.